Healthcare Provider Details

I. General information

NPI: 1952651820
Provider Name (Legal Business Name): SPARROW COMMUNITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S COCHRAN AVE
CHARLOTTE MI
48813-1550
US

IV. Provider business mailing address

3301 E MICHIGAN AVE
LANSING MI
48912-4641
US

V. Phone/Fax

Practice location:
  • Phone: 517-543-0978
  • Fax: 517-541-1548
Mailing address:
  • Phone: 517-364-2115
  • Fax: 517-371-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMI

VIII. Authorized Official

Name: MISTY GUNTER RUSSIAN
Title or Position: REGIONAL MANAGER, PROVIDER ENROLLME
Credential:
Phone: 517-253-6308